Incisions and Excisions

General Risk-Benefit
Minor surgical procedures are regularly performed in our surgery under local anaethetic in one of the consulting rooms. There are advantages and disadvantages as listed here:

  • These are private procedures and other than the standard GMS subsidy a child or adult Community Service Card holder attracts, the cost is fully borne by the patient (or their insurer). Pure cosmetic procedures are generally not offered, but would attract much higher fees.

  • The cost is considerably lower than that charged by specialist surgeons for the same procedure.

  • While sterile and aseptic techniques are used, we do not use the masks, gowns or the positive pressure methods of hospital operating theaters yet we have a much lower post-operative infection rate. Some studies link masks to higher infection rates and the simple trick of not washing off the antiseptic scrub (not generally practised by surgeons) can halve infection rates.

  • Particular attention given to aligning surgical incisions, the use of deep absorbable sutures and the early replacement of external sutures by tapes results in excellent or quite acceptable scars.

  • Procedures requiring skin grafting, extensive or deep exposure are not attempted in the surgery but are referred on to plastic or general surgeons (publically or privately).

Procedures regularly performed include:
repair of lacerations; traumatic skin flap management; biopsy; excision of skin cancers (including melanoma); removal (intact where possible) of sebaceous cysts, lipoma, foreign bodies etc; excision of small tattoos; injection, excision or correction of scars; drainage and/or injection of joints; injection of bursae; incision and drainage of haematoma (especially thrombosed external piles and under nails); incision and drainage of boils and abcesses; ingrowing nail matrix phenolization, (permanent and largely painless); cryotherapy (liquid Nitrogen); sigmoidoscopy; fitting or removal of IUCDs including the Mirena system.

Procedures NOT performed include:
circumcision; Vasectomy except on special request; archilles tendon steroid injections; free skin grafts; tendon repairs; body piercing (cosmetic); collagen and Botox injections; varicose vein injections; surgical removal of keloids (but I will do steroid injections for this) and anything I don't feel competent performing. These are all best seen by surgeons who manage them often enough to maintain competence.

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